Must be currently licensed, certified or registered to practice profession as required by law or regulation in state of practice or policy.
Active RN or LCSW/LMSW license for state(s) covered.
Experience:
5+ years of experience with utilization review, clinical pathways, case management, and disease management are required. Supervisory experience is preferred.
Responsibilities:
manage department operations to assure effective throughput and reimbursement for services provided,
lead the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvement,
ensure medical necessity and revenue cycle processes are completed accurately and in compliance with CMS regulations and the hospital’s policy,
ensure timely and effective patient transition and planning to support efficient patient throughput,
implement and monitor processes to prevent payer disputes,
develop and provide physician education and feedback on hospital utilization,
participate in management of post-acute provider network,
ensure compliance with state and federal regulations and TJC accreditation standards and
other duties as assigned.
Experience:
Required: 3 years of acute hospital case management or healthcare leadership experience
Preferred: 5 years of acute hospital case management leadership multi-site experience
Seniority level
Director
Employment type
Contract
Job function
Health Care Provider
Industries
Staffing and Recruiting
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